Pinta

Synonyms of Pinta

Azul

Carate

Empeines

Lota

Mal del Pinto

Tina

General Discussion

Pinta is a rare infectious tropical disease affecting the skin that is caused by the bacterium Treponema carateum, which is transmitted by direct, nonsexual contact. Pinta progresses through three distinct stages, which are characterized by various skin lesions and discoloration. Other organ systems are not affected. Exposed areas of the skin such as the face and extremities are most often affected.

Pinta is classified as a treponematosis, which is an infectious disease caused by a treponema. Treponemas are a genus of spiral-shaped bacteria (spirochetes). Treponemas caused several infectious diseases including pinta, yaws, and syphilis.

Signs & Symptoms

The symptoms and progression of pinta may vary among affected individuals. Pinta usually progresses in three separate stages: an early phase with initial lesions; an intermediate phase with widespread (disseminated) lesions; and a late phase. The incubation period may range from seven to 21 days. The skin is the only organ involved in pinta.

In most cases, the initial lesions (primary) are small, reddish (erythematous) spots (papules) that occur most often on exposed areas of the arms and legs. The face, neck, chest and abdomen may also be affected. Papules are often itchy (pruritic) and may spread combining to form large plaques. In some cases, nearby lymph nodes may be inflamed (lymphadenitis).

One month to one year after the development of initial lesions, affected individuals may develop secondary skin eruptions called pintids. Pintids are small scaly, reddish lesions that normally affect the same sites as primary lesions. They may be dry and crusted (psoriatic pintids).

Anywhere from three months to a year, secondary lesions and, in some cases, primary lesions may slowly change color from red to brown or slate blue. These lesions may eventually lose their color (depigmentation) becoming white, leaving the skin with a mottled appearance. Pintids may recur for up to 10 years.

The late phase of pinta occurs approximately two to five years after the development of initial lesions and is characterized by white or colorless (achromatic) lesions. During this phase, affected individuals may also develop unusually dry, thickened skin on the soles of the feet and palms of the hands (hyperkeratosis). Eventually, affected individuals may develop dry, wrinkled thin (atrophic) skin in certain areas.

Causes

Pinta is an infectious tropical disease caused by the spiral-shaped bacterium (spirochete) known as Treponema carateum.

Affected Populations

Pinta affects males and females in equal numbers. Most cases are children or adolescents from endemic areas of the world. It is most common in remote rural tropical areas such as the southern portion of Mexico, Central America and Columbia. It occurs with lower incidence rates in various Caribbean Islands. In recent years, only a few hundred cases of pinta have been reported in the medical literature each year. Pinta does not occur in the United States unless affected individuals have visited endemic areas.

The prevalence of pinta declined greatly following a mass treatment campaign with penicillin by the World Health Organzation (WHO) in the 1950s and 60s. The current incidence of pinta is unknown.

Related Disorders

Symptoms of the following disorders can be similar to those of pinta. Comparisons may be useful for a differential diagnosis:

Yaws is an infectious tropical disease caused by the spirochete (spiral shaped) bacterium known as Treponema pertenue. The disease presents in three stages of which the first and second are easily treated. The third, however, may involve complex changes to the bones in many parts of the body. The first stage is characterized by the appearance of small, painless bumps on the skin that group together and grow until they resemble a strawberry. The skin may break open, forming an ulcer. The second stage (usually starting several weeks or months after the first) presents with a crispy, crunchy rash that may cover arms, legs, buttocks and/or face. If the bottoms of the feet are involved, walking is painful and the stage is known as “crab yaws.” Stage 3 yaws involves the long bones, joints, and/or skin. Yaws is very common in tropical areas of the world but rare in the United States. It is not a sexually transmitted disease. (For more information on this disorder, choose “yaws” as your search term in the Rare Disease Database.)

Bejel, also known as endemic syphilis, is an infectious disease that is rare in the United States, but common in certain parts of the world. It is characterized by lesions of the skin and bones and is caused by a bacterium known as Treponema pallidum II. The infection is very similar to syphilis but is not sexually transmitted. Children with Bejel have patchy ulcerations on mucous membranes particularly in or near the mouth. Eventually, the legs, arms, and trunk may become affected. Bone infection occurs later in the disease. (For more information on this disorder, choose “Bejel” as your search term in the Rare Disease Database.)

Acquired syphilis is a chronic infectious disease caused by the bacteria Treponema pallidum. It is transmitted by direct contact with an infected individual, usually through sexual intercourse. When left untreated, the symptoms of syphilis progress (i.e., primary, secondary, and latent stages). Eventually any tissue or organ in the body may be affected. Early symptoms include lesions (chancres) of the skin, anus, vagina, or the moist surfaces of the mouth. The symptoms may remain dormant for years. (For more information on this disorder, choose “Syphilis” as your search term in the Rare Disease Database.)

Vitiligo is a dermatological condition characterized by the appearance of white patches of skin on (depigementation) different parts of the body as a result of the destruction of the cells that make pigment (melanocytes). This may vary from one or two white spots on the skin to large areas of depigmentation. The affected areas most often appear on the face, neck, hands, abdomen and thighs although they can occur on all parts of the skin. Vitiligo is not contagious. It seems to occur more often among people who have certain autoimmune diseases. For some people, although not for everyone, the depigmentation is progressive. (For more information on this disorder, choose “vitiligo” as your search term in the Rare Disease Database.)

Diagnosis

A diagnosis of pinta is suspected based upon a detailed patient history (e.g., recent travel to endemic area), a thorough clinical evaluation, identification of characteristic symptoms, and a variety of tests. These tests may include the microscopic examination of tissue samples (darkfield examination) from the skin lesions of affected individuals. Other blood tests (e.g., VDRL and Treponemal antibody absorption test [FTA-ABS]) usually become positive only after the secondary skin lesions appear.

Standard Therapies

Treatment

The treatment for pinta includes antimicrobial drugs. The drug of choice is benzathine penicillin G. A single large dose of this antibiotic usually heals the skin lesions and eliminates the organism. Primary and secondary lesions often heal within six to 12 months; late phase lesions take more time to resolve. Individuals who are allergic to penicillin may be treated with tetracycline or erythromycin.

Drug therapy may also be used to prevent the disease in family members and others who are in frequent contact with affected individuals.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.

For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

For more information on research on pinta and other tropical diseases, contact the World Health Organization (WHO) listed in the Resources section below.

Resources

Please note that some of these organizations may provide information concerning certain conditions potentially associated with this disorder.

NORD's Rare Disease Database provides brief introductions for patients and their families to more than 1,200 rare diseases. This is not a comprehensive database since there are nearly 7,000 diseases considered rare in the U.S. We add new topics as we are able to do so, with the help of rare disease medical experts.

If you are seeking information about a rare disease that is not in this database, we would suggest contacting the Genetic and Rare Diseases Information Center (GARD) at the National Institutes of Health. NIH has the most complete database of rare diseases in the U.S.

Representatives of patient organizations whose medical advisors are interested in assisting NORD in creating a report on a disease not currently covered in this database may write to orphan@rarediseases.org.